25D2091148 CLIA NUMBER - CHILDREN'S INTERNATIONAL MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 25D2091148
  • Facility Name: CHILDREN'S INTERNATIONAL MEDICAL GROUP
  • Facility Address: 11240 HWY 49 #C
    GULFPORT, MS
    ZIP 39503
  • Facility Phone: 228 831-8800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDUARDO J. HERNANDEZ
  • NPI Number: 1023549219
  • Taxonomy: 261QP2300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D2091148
LAB Type Physician Office
Facility Name CHILDREN'S INTERNATIONAL MEDICAL GROUP
Street 11240 HWY 49 #C
City GULFPORT
State MS
ZIP 39503
Phone 228 831-8800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2025
Certificate Expiration Date 2/5/2027
Facility Type Physician Office
Lab Director EDUARDO J. HERNANDEZ

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 9/29/2025